Lump it or leave it

If you’re a lesbian and you want to take the drug Accutane you may be forced to make a choice: lie about your sex life or go on the pill.

The acne drug, manufactured by Swiss pharmaceutical giant Hoffman-La Roche, is known to cause severe birth defects in babies born to mothers who’ve been on it just prior to conception. As a result, it comes along with an informed consent form and pregnancy prevention checklist for female patients to sign. But the form only offers two options – complete abstinence or two forms of effective birth control.

“I didn’t like having to lie about it,” says a lesbian patient, who asked that she not be identified. “I have no problem with my sexual orientation and I didn’t want to say I’m abstaining from sex. My girlfriend didn’t appreciate it.”

She says that she didn’t broach the possibility of an alternative arrangement with her dermatologist because she’d already been told by a previous doctor that if she refused to sign the form, she wouldn’t get the drug.

“I waited three months for this appointment so I wasn’t going to do anything that would make me wait another three months.”

Dr Christopher McIntosh, of the Southern Ontario Gay And Lesbian Association Of Doctors (SOGLAD), says that this is indicative of the heterosexism that continues to exist in the medical profession.

“There’s a valid concern because Accutane is one of the worst drugs for causing birth defects. But it would be so easy just to alter the form to say if you are not having sex with men. You can only conclude that it would be ignorance because it would be so simple to change the form.”

He adds that SOGLAD often uses this example – a woman who tells her doctor she’s sexually active and is automatically questioned on her use of birth control – to educate their colleagues on how queer patients fall through the cracks.

“It’s so funny how people seem to assume there’s only one kind of sex,” he says. “I find that baffling. Obviously it’s very heterosexist.”

Toronto dermatologist Dr Daniel Schachter says that there’s a strong push from both the drug company and regulatory agencies not to prescribe Accutane unless the patient signs all the forms.

“Signing is for the protection of many,” he says. “You’re protecting the patient, you’re protecting the doctor. You don’t want to get into a situation where they may get into problems.”

He says it’s not always clear how to deal with lesbian patients.

“If somebody says ‘Okay get off my case I’m not going on the birth control pill, I’ll never need it,’ then I have to say, ‘Well you might.'”

Schachter says that it’s important to consider the possibility that a patient will become pregnant unexpectedly.

“For whatever reason they may become sexually active [with men] in the next year. They may be bisexual or there’s the contingency where somebody does get raped. These issues need to broached. As much as possible make sure they understand all the risks.”

But these scenarios would also be true of women who choose the abstinence option.

“It’s touchy,” he admits. “Certain segments of the population feel that they’re not being treated fairly. I think when you’re going on an important medication you have to protect the people. I’m not sure that people always see it as protection.”

Neither Health Canada nor Hoffman-La Roche are jumping to take responsibility for improving the form.

“It is a document owned by the company,” says Health Canada media representative Ryan Baker. He adds that Health Canada doesn’t have the authority to require changes unless there’s an identified health risk, which there isn’t in this case.

That said, Baker says that Health Canada does have the issue on the radar screen.

“Health Canada is reviewing this issue with company,” says Baker. “But I know nothing beyond that. Whether that would result in a change, it’s too soon to say.”

“We’ve created [the form] and it’s been seen and approved by Health Canada,” says Samantha Ouimet, Hoffman-La Roche’s national manager of product and corporate communications.

“[The document] was there because we were working with Health Canada. They do monitor materials put out by all pharmaceutical companies.”

When asked how the company would expect a lesbian to fill out the form, Ouimet replied, “This is a pregnancy prevention checklist. That’s what it’s for. I don’t have a response for that.”